Women have choices to cope with menopause

More than 20 years ago, author Gail Sheehy wrote a groundbreaking book, "The Silent Passage," which uncovered her frustrations and those of other women going through the transition to menopause.

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By Suzanne Laurent

seacoastonline.com

By Suzanne Laurent

Posted Aug. 25, 2013 at 2:00 AM

By Suzanne Laurent

Posted Aug. 25, 2013 at 2:00 AM

» Social News

More than 20 years ago, author Gail Sheehy wrote a groundbreaking book, "The Silent Passage," which uncovered her frustrations and those of other women going through the transition to menopause.

Generations of women before her silently suffered the hot flashes, night sweats, sleep disturbances, and sometimes depression and anxiety during what Sheehy called "the gateway to a second adulthood."

Since then, many women have felt empowered to talk with primary care practitioners about their symptoms.

Menopause is when a woman's ovaries stop producing the hormones estrogen and progesterone. The years leading up to a woman's last period are called the menopausal transition or perimenopause.

During perimenopause, a woman's periods can stop for a while, then start again. Once a woman has not had a period for one year, she has gone through menopause. The average age for menopause is 51 or 52, but for some women it happens as early as 40 or as late as 55.

Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopausal transition symptoms. Hormone therapy, as it's now called, was also thought to have the long-term benefits of preventing heart disease and dementia.

But a 2002 study published by the Women's Health Initiative of the National Institutes of Health found an increased risk of breast cancer, heart attacks and stroke, especially in women who started hormone therapy after age 60. The 2002 study alarmed women in their 50s who were taking the therapy, as well as younger women who began hormone therapy after removal of their ovaries that put them into surgical menopause and women who were postmenopausal.

"The current benchmark is to take hormone therapy for three years," said Dr. Sonja Nelson of Harbor Women's Health in Portsmouth. "And this is for women who are experiencing a lot of menopausal symptoms."

Nelson said hormone therapy is used in the lowest doses possible to manage the symptoms and sometimes women only need it for about a year.

"We slowly wean women off the therapy when we agree it's time," she said.

A woman is considered postmenopausal after she has not had her period for 12 consecutive months. Nelson cautions that women may have a period after not having one for months during this transition.

"If it's a very normal period, that's OK," she said. "If there is excess bleeding or irregular bleeding, the woman should be seen to rule out other causes such as endometrial cancer."

Women who have a history of breast cancer or a strong family history of breast cancer should not take hormone therapy.

"If they are suffering from symptoms, I will refer them to an acupuncturist who can also prescribe Chinese herbal medicines," Nelson said.

Dr. Angela Lambert, a naturopathic doctor based in Portsmouth, treats many women for menopausal symptoms.

"Often menopause is viewed, and treated, as though it were a disease," Lambert said. "Menopause is not a disease — it's a part of the process of life as a woman."

Lambert said when symptoms are extreme, "it is the body's way of telling us that something is out of balance."

She has found a combination of acupuncture, homeopathic remedies (such as flower extracts) and Chinese herbal formulas has been very effective with many women. A typical acupuncture protocol would include treatments two times a week for two to three weeks, then reducing to once a week for three to four weeks.

"Women can usually tell within a few visits if this form of treatment would be effective," Lambert said. "Acupuncture alone is great, but used in combination with herbal or homeopathic therapy, it is more effective."

The basic foundation for Oriental medicine is that there is a life energy flowing through the body called qi (pronounced chee). This energy flows through the body on channels known as meridians that connect all of our major organs. Acupuncture is the stimulation of specific points near or on the surface of the skin that have the ability to alter various biochemical and physiological conditions to achieve a desired effect.

Herbal formulas can help, too.

"Many people focus on black cohosh but that is not the right protocol for all women," Lambert said. "Ideally, one should get a specific protocol created for their symptoms and challenges."

Acupuncturists and naturopathic doctors use combinations of Chinese herbs that are specific to a woman's symptoms.

Eating healthy, regular exercise and eliminating alcohol can also help with menopausal symptoms.

"As women's hormone levels go down, they tend to gain weight," said Jacquie Higgins, a registered dietitian and the clinical nutrition manager at Portsmouth Regional Hospital. "As estrogen decreases, they crave more fat and sugar. And the fat tends to store around the abdominal area."

During this time, a woman's metabolic rate goes down and she needs to exercise more to combat weight gain, Higgins said. She recommends 30 minutes of moderately intense exercise most days of the week. This can also be as simple as taking the stairs or parking the car further away from entrances.

"It's important to avoid foods that trigger symptoms such as caffeine and spicy foods," Higgins said. She also recommends adding more fruits, vegetables and three servings a day of whole grains.

While some women breeze through menopause, others may experience severe symptoms that should be evaluated by a primary care practitioner.

Decreased hormones can make vaginal tissues drier and thinner, which can make sex uncomfortable for some women. This, too, should be discussed with a doctor. There are some over-the-counter vaginal lubricants and some women may be prescribed pills or creams that contain the male hormone testosterone or similar products.

"Women are living longer, are more aware of their symptoms and want a better quality of life," Nelson said.